scholarly journals Risk of Bacterial Infection in Acquired Complement Deficiencies

2020 ◽  
Author(s):  
Taha Al-Shaikhly ◽  
Kristen Hayward ◽  
Matthew L Basiaga ◽  
Eric J Allenspach
Keyword(s):  
Logistic Regression ◽  
Bacterial Infection ◽  
Lupus Erythematosus ◽  
Perceived Risk ◽  
Logistic Regression Model ◽  
Pediatric Patients ◽  
Complement Deficiency ◽  
Complement Components ◽  
Related Disease ◽  
Total Complement

Abstract Background: Acquired complement deficiency can occur in the setting of autoimmune syndromes, such as systemic lupus erythematosus (SLE), with very low or, occasionally, undetectable C3 levels. Based on data from patients with inherited complement defects, a perceived risk for serious bacterial infection exists amongst patients with transiently low complement, but the degree of risk related to C3 level is unknown. Methods: We performed a retrospective study of all pediatric patients with an undetectable total complement activity or absent individual complement components measured at our institution from 2002 to 2018. We assessed annual rate of serious bacterial infection (SBI) defined as requiring hospitalization and/or parenteral antibiotics. Among included SLE patients, we assessed the 30-day probability of SBI for given C3 measurements using a logistic regression model to determine risk. Results: Acquired complement deficiency secondary to SLE-related disease [n=44] was the most common underlying diagnosis associated with depressed complement levels. While controlling for immunosuppression level and lupus nephritis diagnosis, our logistic regression analysis of pediatric patients with SLE showed low C3 level was temporally associated with having an SBI event. Even in patients with equivalent immunosuppression, patients with an SBI were found to have lower C3 levels preceding the infection relative to patients without SBI. Conclusion: Pediatric patients with the diagnosis of SLE can develop very low C3 levels that are independently associated with risk of serious bacterial infection. Patients prone to complement consumption may particularly be at risk.

scholarly journals Bacterial infections in a pediatric cohort of primary and acquired complement deficiencies.

2020 ◽  
Author(s):  
Taha Al-Shaikhly ◽  
Kristen Hayward ◽  
Matthew L Basiaga ◽  
Eric J Allenspach
Keyword(s):  
Logistic Regression ◽  
Bacterial Infection ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Complement Deficiency ◽  
Temporal Association ◽  
Complement Components ◽  
History Of ◽  
Total Complement

Abstract Background: Acquired complement deficiency can occur in the setting of autoimmune syndromes, such as systemic lupus erythematosus (SLE), with very low or, occasionally, undetectable C3 levels. Based on inherited complement defects, patients with transiently low complement may be at similar risk for serious bacterial infection, but the degree of risk related to C3 level and temporal association is unknown. Methods: We performed a retrospective study including pediatric patients with undetectable total complement activity or absent individual complement components measured at our institution from 2002 to 2018. We assessed annual rate of serious bacterial infection (SBI) defined as requiring hospitalization and/or parenteral antibiotics by manual chart review. Among included SLE patients, we assessed the 30-day probability of SBI for given C3 measurements using a logistic regression model to determine risk. Primary complement deficiency was analyzed for SBI rate as comparison. Covariates included age, level of immune suppression and history of lupus nephritis.Results: Acquired complement deficiency secondary to SLE-related disease [n=44] was the most common underlying diagnosis associated with depressed complement levels and were compared to a cohort of primary complement deficient patients [n=18]. SBI per 100 person-years and cohort demographics were described in parallel. Our logistic regression analysis of pediatric patients with SLE showed low C3 level was temporally associated with having an SBI event. Given equivalent immunosuppression, patients with an SBI had lower C3 levels at the beginning of the observation period relative to patients without SBI. Conclusion: Pediatric patients with the diagnosis of SLE can develop very low C3 levels that associate with risk of serious bacterial infection comparable to that of patients with primary complement deficiency. Patients prone to severe complement consumption may particularly be at risk.

scholarly journals Bacterial infections in a pediatric cohort of primary and acquired complement deficiencies

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Taha Al-Shaikhly ◽  
Kristen Hayward ◽  
Matthew L. Basiaga ◽  
Eric J. Allenspach
Keyword(s):  
Logistic Regression ◽  
Bacterial Infection ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Complement Deficiency ◽  
Temporal Association ◽  
Complement Components ◽  
History Of ◽  
Total Complement

Abstract Background Acquired complement deficiency can occur in the setting of autoimmune syndromes, such as systemic lupus erythematosus (SLE), with very low or, occasionally, undetectable C3 levels. Based on inherited complement defects, patients with transiently low complement may be at similar risk for serious bacterial infection, but the degree of risk related to C3 level and temporal association is unknown. Methods We performed a retrospective study including pediatric patients with undetectable total complement activity or absent individual complement components measured at our institution from 2002 to 2018. We assessed annual rate of serious bacterial infection (SBI) defined as requiring hospitalization and/or parenteral antibiotics by manual chart review. Among included SLE patients, we assessed the 30-day probability of SBI for given C3 measurements using a logistic regression model to determine risk. Primary complement deficiency was analyzed for SBI rate as comparison. Covariates included age, level of immune suppression and history of lupus nephritis. Results Acquired complement deficiency secondary to SLE-related disease [n = 44] was the most common underlying diagnosis associated with depressed complement levels and were compared to a cohort of primary complement deficient patients [n = 18]. SBI per 100 person-years and cohort demographics were described in parallel. Our logistic regression analysis of pediatric patients with SLE showed low C3 level was temporally associated with having an SBI event. Given equivalent immunosuppression, patients with an SBI had lower C3 levels at the beginning of the observation period relative to patients without SBI. Conclusion Pediatric patients with the diagnosis of SLE can develop very low C3 levels that associate with risk of serious bacterial infection comparable to that of patients with primary complement deficiency. Patients prone to severe complement consumption may particularly be at risk.

scholarly journals Long Noncoding RNA THAP9-AS1 and TSPOAP1-AS1 Provide Potential Diagnostic Signatures for Pediatric Septic Shock

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yong Wu ◽  
Qigai Yin ◽  
Xiaobao Zhang ◽  
Pin Zhu ◽  
Hengfei Luan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Pediatric Patients ◽  
R Package ◽  
Differentially Expressed ◽  
Blood Samples ◽  
Health Control ◽  
Control Samples

Background. Sepsis is a systemic inflammatory syndrome caused by infection with a high incidence and mortality. Although long noncoding RNAs have been identified to be closely involved in many inflammatory diseases, little is known about the role of lncRNAs in pediatric septic shock. Methods. We downloaded the mRNA profiles GSE13904 and GSE4607, of which GSE13904 includes 106 blood samples of pediatric patients with septic shock and 18 health control samples; GSE4607 includes 69 blood samples of pediatric patients with septic shock and 15 health control samples. The differentially expressed lncRNAs were identified through the limma R package; meanwhile, GO terms and KEGG pathway enrichment analysis was performed via the clusterProfiler R package. The protein-protein interaction (PPI) network was constructed based on the STRING database using the targets of differently expressed lncRNAs. The MCODE plug-in of Cytoscape was used to screen significant clustering modules composed of key genes. Finally, stepwise regression analysis was performed to screen the optimal lncRNAs and construct the logistic regression model, and the ROC curve was applied to evaluate the accuracy of the model. Results. A total of 13 lncRNAs which simultaneously exhibited significant differences in the septic shock group compared with the control group from two sets were identified. According to the 18 targets of differentially expressed lncRNAs, we identified some inflammatory and immune response-related pathways. In addition, several target mRNAs were predicted to be potentially involved in the occurrence of septic shock. The logistic regression model constructed based on two optimal lncRNAs THAP9-AS1 and TSPOAP1-AS1 could efficiently separate samples with septic shock from normal controls. Conclusion. In summary, a predictive model based on the lncRNAs THAP9-AS1 and TSPOAP1-AS1 provided novel lightings on diagnostic research of septic shock.

scholarly journals Preoperative Fasting Time and Its Association with Hypoglycemia during Anesthesia in Pediatric Patients Undergoing Elective Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hussien Endris Assen ◽  
Anissa Mohammed Hassen ◽  
Ananya Abate ◽  
Bikis Liyew
Keyword(s):  
Logistic Regression ◽  
Logistic Regression Model ◽  
Pediatric Patients ◽  
Addis Ababa ◽  
Preoperative Fasting ◽  
Solid Foods ◽  
Glucose Levels ◽  
Specialized Hospital ◽  
Tikur Anbessa Specialized Hospital ◽  
Fasting Time

Background. Preoperative fasting is important to reduce the risk of pulmonary aspiration during anesthesia. The influence of prolonged fasting time on glucose levels during anesthesia in children remains uncertain. Therefore, this study is aimed at assessing preoperative fasting time and its association with hypoglycemia during anesthesia in pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The research hypothesis of the study is as follows: there is a prolonged preoperative fasting time, and it influences the glucose levels during anesthesia among pediatric patients undergoing elective procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods. Institutional based cross-sectional study was conducted among 258 pediatric patients who had undergone elective procedures in a tertiary care center. A systematic sampling method was used to select study participants. The data were collected through face-to-face interviews and medical record reviews. Binary logistic regression was used to identify associated factors of hypoglycemia during anesthesia among pediatric patients undergoing elective procedures. All explanatory variables with a p value of ≤0.25 from the bivariable logistic regression model were fitted into the multivariable logistic regression model to control the possible effect of confounders, and finally, the variables which had an independent association with hypoglycemia were identified based on adjusted odds ratio with 95% confidence interval, and a p value less than 0.05 was significant. Results. The mean (standard deviation) fasting hours from breast milk, solid foods, and clear fluids were 7.75 (2.89), 13.25 (3.14), and 12.31 (3.22), respectively. The majority (89.9%, 57.9%, and 100%) of participants had fasted from solid, breast milk, and clear fluids for more than 8, 6, and 4 hours, respectively. More than one-fourth (26.2%) of participants were hypoglycemic immediately after induction. Residence, order of nothing per mouth, source of patient, and duration of fasting from solid foods had a significant association with hypoglycemia during anesthesia in children. Conclusion. Children undergoing elective procedures were exposed to unnecessarily long fasting times which were associated with hypoglycemia during anesthesia.

scholarly journals FRI0606-HPR REMISSION IN SYSTEMIC LUPUS ERYTHEMATOSUS, WHAT IS THE IMPACT ON ACCUMULATED DAMAGE?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 908.3-909
Author(s):  
F. J. Hüttmann ◽  
A. L. Barbaglia ◽  
L. Gonzalez Lucero ◽  
H. R. Sueldo ◽  
M. C. Bertolaccini ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Logistic Regression Model ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Accumulated Damage ◽  
Baseline Visit

Background:The objective of the treatment in rheumatic diseases is to achieved the remission or minimal disease activity of these patients. Previous studies in Systemic Lupus Erythematosus (SLE) showed that reaching remission had a positive impact on the prognosis of the disease.Objectives:To determine the frequency of remission in a cohort of patients with SLE.To evaluate the effect of disease activity on accrual damage.Methods:A retrospective study was carried out from January 2010 to December 2018. Clinical records of patients with SLE (ACR criteria 1982/97) were reviewed considering baseline visit as the first clinical or control visit of 2010. For subsequent visits, data were collected annually until 2018. SLE activity was defined for each visit according to GLADEL´s definition: 1- Remission Without Treatment (RwT): SLEDAI 0, without prednisone or immunosuppressive drugs (IS); 2- Remission on Treatment (RoT): SLEDAI 0, prednisone up to 5mg/day or immunosuppressive drugs in maintenance doses; 3- LDAS (Low Disease Activity Status): SLEDAI ≤ 4, prednisone up to 7.5mg/ ay and/or IS in maintenance doses; 4- Non-Optimal Activity Control (NOC): SLEDAI> 4, prednisone> 7.5 mg/day and/or IS in induction dose. The use of hydroxychloroquine was allowed for all groups. For the analysis, patients who remained in remission (with and without treatment) or LDAS for at least 75% of the follow-up time were grouped and compared with patients who remained active during that same period. Demographic, laboratory, treatment related variables and death were studied. Accrual damage was assessed with SLICC / SDI. Patients with less than two annual visits were excluded.Statistical analysis: descriptive measures, Test T, Mann Whitney, Chi2 Test, Fisher’s exact test, bivariate correlation, logistic regression model with mixed effects.Results:Two hundred eighty-five medical records were reviewed and 100 patients with SLE were included, 89% women, mean age at baseline visit 38.5 ± 12 years old and mean time of disease 9.3 ± 7.3 years. The average SLEDAI and SLICC/SDI baseline scores were 3.7 and 0.8 respectively. The SLICC/ SDI score at last visit was 2.2 and the average SLICC/SDI change (ΔSLICC) compared to baseline visit score was 1.4 ± 1.6.The prevalence of patients who were in remission for at least 75% of the follow-up time was 38% [95% CI 26.6, 45.4]. NOC patients categorized at baseline visit had the highest ΔSLICC (p 0.0001). The ΔSLICC was significantly lower in patients who were at least 75% of the follow-up time in remission (p 0.01) or LDAS (p 0.01) compared to those with NOC. In the Logistic Regression Model, the chance of changing the SLICC/SDI score was 2.9 times higher for the NOC group than for RwT.Conclusion:The frequency of remission in this cohort of patients with SLE was 38%.Worse control of disease activity, was associated with higher accumulated damage.Disclosure of Interests:None declared

scholarly journals PK/PD Study of Mycophenolate Mofetil in Children With Systemic Lupus Erythematosus to Inform Model-Based Precision Dosing

2020 ◽  
Vol 11 ◽  
Author(s):  
Yewei Chen ◽  
Li Sun ◽  
Hong Xu ◽  
Min Dong ◽  
Tomoyuki Mizuno ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Logistic Regression ◽  
Mycophenolate Mofetil ◽  
Lupus Erythematosus ◽  
Pediatric Patients ◽  
Pharmacokinetic Parameters ◽  
Pharmacokinetic Data ◽  
Systemic Lupus ◽  
Sledai Score ◽  
Exposure Response

Objectives: To evaluate the mycophenolic acid [MPA, the active form of mycophenolate mofetil (MMF)] pharmacokinetic parameters in relation to clinical response to identify target exposure ranges in pediatric patients with systemic lupus erythematosus (SLE).Methods: This was a retrospective study using pharmacokinetic data collected in 67 pediatric patients aged 4–18 years with SLE. Target MPA exposures for effective inhibition of SLE activity (as measured by SLE disease Activity Index (SLEDAI), active SLE was defined as a SLEDAI score of ≥6, and a controlled disease was defined as a SLEDAI score of ≤4) were assessed by receiver operating characteristic (ROC) curve and logistic regression. Exposure-response models were developed to quantitatively describe the relationship between SLEDAI score and AUC0–12 or Ctrough, respectively.Results: The MPA AUC0-12 in patients with active SLE was significantly lower than that in patients with inactive SLE. ROC analysis revealed that an AUC0–12 threshold of 39 μg h/ml or a Ctrough of 1.01 μg/ml was associated with the lowest risk of active SLE. Logistic regression analysis revealed that an AUC0–12 of less than 34 μg h/ml or a Ctrough of less than 1.2 μg/ml probably is associated with active SLE. The results of the exposure-response modeling also indicated that an AUC0-12 less than 32 μg h/ml or a Ctrough less than 1.1 μg/ml was associated with suboptimal clinical outcome. An AUC0-12 above 50 μg h/ml or a Ctrough above 1.7 ug/ml was associated with disease control.Conclusion: Both AUC0–12 and Ctrough of MPA are predictive of the likelihood of active SLE in pediatric patients receiving MMF. An individualized dosing regimen of MMF, with a target AUC0–12 or Ctrough, should be considered for SLE patients.

Unplanned, Postoperative Intubation in Pediatric Surgical Patients

2016 ◽  
Vol 125 (5) ◽  
pp. 914-928 ◽  
Author(s):  
Eric C. Cheon ◽  
Hannah L. Palac ◽  
Kristine H. Paik ◽  
John Hajduk ◽  
Gildasio S. De Oliveira ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Pediatric Patients ◽  
Postoperative Mortality ◽  
Operation Time ◽  
Noncardiac Surgery ◽  
Improvement Program ◽  
Physical Status Classification ◽  
Increased Risk

Abstract Background To date, the independent predictors and outcomes of unplanned postoperative intubation (UPI) in pediatric patients after noncardiac surgery are yet to be characterized. The authors aimed to identify the incidence and predictors of this event and evaluated the effect of this event on postoperative mortality. Methods Data of 87,920 patients from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database were analyzed and assigned to derivation (n = 58,614; 66.7%) or validation (n = 29,306; 33.3%) cohorts. The derivation cohort was analyzed for the incidence and independent predictors of early UPI. The final multivariable logistic regression model was validated using the validation cohort. Results Early UPI occurred with an incidence of 0.2% in both cohorts. Among the 540 patients who experienced a UPI, 178 (33.0%) were intubated within the first 72 h after surgery. The final logistic regression model indicated operation time, severe cardiac risk factors, American Society of Anesthesiologists physical status classification more than or equal to 2, tumor involving the central nervous system, developmental delay/impaired cognitive function, past or current malignancy, and neonate status as independent predictors of early UPI. Having an early UPI was associated with an increased risk of unadjusted, all-cause 30-day mortality, demonstrating an odds ratio of 11.4 (95% CI, 5.8 to 22.4). Conclusions Pediatric patients who experienced an early UPI after noncardiac surgery had an increased likelihood of unadjusted 30-day mortality by more than 11-fold. Identification of high-risk patients can allow for targeted intervention and potential prevention of such outcomes.

scholarly journals Association of postoperative furosemide use with a reduced blood transfusion rate in sagittal craniosynostosis surgery

2016 ◽  
Vol 17 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Adil Harroud ◽  
Alexander G. Weil ◽  
Jean Turgeon ◽  
Claude Mercier ◽  
Louis Crevier
Keyword(s):  
Logistic Regression ◽  
Blood Transfusion ◽  
Logistic Regression Model ◽  
Pediatric Patients ◽  
Control Group ◽  
Transfusion Rate ◽  
Multiple Logistic Regression ◽  
Sagittal Craniosynostosis ◽  
The Impact ◽  
Furosemide Administration

OBJECT A major challenge in sagittal craniosynostosis surgery is the high transfusion rate (50%–100%) related to blood loss in small pediatric patients. Several approaches have been proposed to prevent packed red blood cell (PRBC) transfusion, including endoscopic surgery, erythropoietin ortranexamic acid administration, and preoperative hemodilution. The authors hypothesized that a significant proportion of postoperative anemia observed in pediatric patients is actually dilutional. Consequently, since 2005, at CHU Sainte-Justine, furosemide has been administered to correct the volemic status and prevent PRBC transfusion. The purpose of this study was to evaluate the impact of postoperative furosemide administration on PRBC transfusion rates. METHODS This was a retrospective study of 96 consecutive patients with sagittal synostosis who underwent surgery at CHU Sainte-Justine between January 2000 and May 2012. The mean age at surgery was 4.9 ± 1.5 months (range 2.8–8.7 months). Patients who had surgery before 2005 constituted the control group. Those who had surgery in 2005 or 2006 were considered part of an implementation phase because furosemide administration was not routine. Patients who had surgery after 2006 were part of the experimental (or furosemide) group. Transfusion rates among the 3 groups were compared. The impact of furosemide administration on transfusion requirement was also measured while accounting for other variables of interest in a multiple logistic regression model. RESULTS The total transfusion rate was significantly reduced in the furosemide group compared with the control group (31.3% vs 62.5%, respectively; p = 0.009), mirroring the decrease in the postoperative transfusion rate between the groups (18.3% vs 50.0%, respectively; p = 0.003). The postoperative transfusion threshold remained similar throughout the study (mean hemoglobin 56.0 g/dl vs 60.9 g/dl for control and furosemide groups, respectively; p = 0.085). The proportion of nontransfused patients with recorded hemoglobin below 70 g/dl did not differ between the control and furosemide groups (41.7% vs 28.6%, respectively; p = 0.489). Surgical procedure, preoperative hemoglobin level, estimated blood loss, and furosemide administration significantly affected the risk of receiving a postoperative PRBC transfusion. When these variables were analyzed in a multiple logistic regression model, furosemide administration remained strongly associated with a reduced risk of being exposed to a blood transfusion (OR 0.196, p = 0.005). There were no complications related to furosemide administration. CONCLUSIONS A significant part of the postoperative anemia observed in patients who underwent sagittal craniosynostosis surgery was due to hypervolemic hemodilution. Correction of the volemic status with furosemide administration significantly reduces postoperative PRBC transfusion requirements in these patients.

The Effect of Sanctions on Cooperative Behavior: A Study on Medium Trust Individuals in the Context of Corruption

2018 ◽  
Vol 34 (1) ◽  
Author(s):  
Dewi Rosiana ◽  
Achmad Djunaidi ◽  
Indun Lestari Setyono ◽  
Wilis Srisayekti
Keyword(s):  
Logistic Regression ◽  
Public Interest ◽  
Logistic Regression Model ◽  
Cooperative Behavior ◽  
Research Subjects ◽  
Chi Square ◽  
Public Interests ◽  
The Public ◽  
Chi Square Analysis ◽  
Personal Interests

This study aims to describe the effect of sanctions (individual sanctions, collective sanctions, and absence of sanctions) on cooperative behavior of individuals with medium trust in the context of corruption. Both collective sanctions and individual sanctions, are systemic, which means sanctioning behavior is exercised not by each individual but by the system. Cooperative behavior in this context means choosing to obey rules, to reject acts of corruption and to prioritize public interests rather than the personal interests. Conversely, corruption is an uncooperative behavior to the rules, and ignores the public interest and prioritizes personal interests. Research subjects were 62 students. The Chi-Square Analysis was used to see the association between the variables and the logistic regression model was applied to describe the structure of this association. Individual sanction is recommended as punishment to medium trust individuals to promote cooperative behavior in the context of corruption. The results showed that individuals with medium trust had more cooperative behavior.

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